NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

National Healthcare Issue/Stressor

One significant problem in healthcare across America is the existence of disparities in healthcare. These disparities affect specific ethnic, social, and economic groups. Many of these groups live in rural and underserved areas where healthcare providers are scarce. Additionally, chronic diseases disproportionately impact these populations. Unfortunately, factors such as race, socioeconomic status, educational level, and residency often make it difficult to change these circumstances. However, everyone should have access to healthcare that is affordable, safe, effective, and accessible. Initiatives like the Triple Aim and Quadruple Aim aim to bridge healthcare gaps, with a focus on Advance Practice Registered Nurses (APRNs) in Interprofessional Organizational and Systems Leadership.

The Triple Aim and Quadruple Aim are essential principles in the healthcare industry and within healthcare organizations. The Triple Aim consists of three critical components: improving the health of populations, containing healthcare costs, and enhancing the quality of patient care (Broome & Marshall, 2021). The Quadruple Aim adds a fourth element that concentrates on improving the work environment for healthcare professionals. The inclusion of this fourth component is crucial in achieving the goals of the Triple Aim. In my work setting, the primary focus is on improving population health and staff morale.

In correctional nursing, healthcare disparities among inmates are more pronounced than in the general public. According to Nowotny et al. (2017), the overall health of incarcerated individuals is inadequate and worse than that of those not in prison, particularly concerning chronic conditions. Additionally, staffing shortages are a persistent issue in healthcare within correctional facilities, making it challenging to recruit and retain quality healthcare professionals to provide appropriate care to detainees. Staff members are often required to work beyond the standard 40-hour workweek, leading to exhaustion. Consequently, the work environment becomes stressful, and staff burnout is a reality.

Response to Healthcare Issue/Stressor in the Work Setting and Changes Implemented

Comparison Between Pennsylvania and Texas APRN Board of Nursing Regulations

To address healthcare disparities and improve working conditions, the correctional facility has placed a significant focus on recruiting and retaining qualified healthcare professionals, including APRNs. Nurse Practitioners play a vital role in delivering healthcare in prisons and primary care settings. Moreover, there has been an increase in the graduation rates of APRNs compared to physicians, which has positively impacted the workforce without compromising the quality of patient care or increasing healthcare costs (Auerbach et al., 2018). The Department of Justice offers incentives such as retention, recruitment, relocation pay, and student loan repayment to nurses and other healthcare professionals (U.S. Department of Justice, 2016). Additionally, at my correctional institution, various initiatives, including an exercise center and health fairs, have been implemented. These efforts have made the correctional facility more competitive in hiring, resulting in improved staff morale, decreased burnout, and enhanced healthcare quality, thereby reducing disparities.

Conclusion

Health disparities are a significant issue in both private and institutional healthcare settings. However, with the implementation of the Triple/Quadruple Aim principles and the involvement of APRNs, progress can be made in reducing these disparities.

References

Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians—Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358–2360.

Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Nowotny, K. M., Rogers, R. G., & Boardman, J. D. (2017). Racial disparities in health conditions among prisoners compared with the general population. SSM – Population Health, 3, 487–496.

U.S. Department of Justice. (2016). Federal Bureau of Prisons: Program Statement. Retrieved from https://www.bop.gov/policy/progstat/3530.02.pdf

Module 1: Healthcare Environment (Weeks 1-2)
Learning Objectives

Students will:

Analyze current national healthcare issues/stressors
Analyze the impact of national healthcare issues/stressors on healthcare organizations
Analyze strategies for addressing national healthcare issues/stressors

Due By Assignment
Week 1, Days 1–2 Read the Learning Resources. Compose your initial Discussion post.
Week 1, Day 3 Post your initial Discussion post. Begin to compose your Assignment.
Week 1, Days 4-5 Review peer Discussion posts. Compose your peer Discussion responses. Continue to compose your Assignment.
Week 1, Day 6 Post two peer Discussion responses.
Week 2, Days 1–6 Continue to compose your Assignment.
Week 2, Day 7 Deadline to submit your Assignment.

Required Readings

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Chapter 2, “Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 34–62)
Chapter 3, “Current Challenges in Complex Health Care Organizations and the Quadruple Aim” (pp. 66–97)
Read any TWO of the following (plus TWO additional readings on your selected issue):
Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians—Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358–2360.
Gerardi, T., Farmer, P., & Hoffman, B. (2018). Moving closer to the 2020 BSN-prepared workforce goal. American Journal of Nursing, 118(2), 43–45.
Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being: Moving from the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42(3), 231–245.
Norful, A. A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain. Annals of Family Medicine, 16(3), 250–256.
Palumbo, M., Rambur, B., & Hart, V. (2017). Is health care payment reform impacting nurses’ work settings, roles, and education preparation? Journal of Professional Nursing, 33(6), 400–404.
Park, B., Gold, S. B., Bazemore, A., & Liaw, W. (2018). How evolving United States payment models influence primary care and its impact on the Quadruple Aim. Journal of the American Board of Family Medicine, 31(4), 588–604.
Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(56

), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3
Poghosyan, L., Norful, A., & Laugesen, M. (2018). Removing restrictions on nurse practitioners’ scope of practice in New York state: Physicians’ and nurse practitioners’ perspectives. Journal of the American Association of Nurse Practitioners, 30(6), 354–360.
Ricketts, T., & Fraher, E. (2013). Reconfiguring health workforce policy so that education, training, and actual delivery of care are closely connected. Health Affairs, 32(11), 1874–1880.
Required Media
Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: Author.

NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership

National Healthcare Issue/Stressor

A national healthcare issue/stressor affecting healthcare systems across America is disparities in healthcare. The inequalities in healthcare relate to specific ethnic, social, and economic groups. Many of those groups reside in rural and underserved populations where healthcare providers are scarce. Also, chronic diseases disproportionately affect these populations. However, social determinants such as race, socioeconomic status, educational level, and residency are sometimes unchangeable circumstances. Everyone deserves healthcare that is accessible, safe, effective, and affordable. The Triple Aim and Quadruple Aim are initiatives to assist with bridging healthcare gaps and Advance Practice Registered Nurses (APRNs) NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

The Triple Aim and Quadruple Aim relate to essential principles for delivering in the healthcare industry and specifically in individual healthcare organizations. The Triple Aim has three critical components the health of populations, containment cost of healthcare, and improved quality of patient care (Broome & Marshall, 2021). The Quadruple Aim adds another standard that focuses on bettering the work environment of healthcare workers. The addition of the fourth component is paramount in the achievement of the Triple Aim goals. The focal points of my work setting will be improving population health and work enthusiasm.

In correctional nursing, healthcare disparities among the inmate population are more remarkable than that of the general public. According to Nowotny et al. 2017, those incarcerated’ overall health is inadequate and worse than those not in prison, especially chronic conditions. Besides, healthcare worker vacancies are always an issue, and prison positions are hard to fill. Thus, it is difficult to recruit and retain quality healthcare professionals to treat detainees appropriately. The staff has to work additional mandatory hours beyond the 40-hour workweek, which is exhausting. So, the work environment is stressful, and staff burnout is a reality due to staffing shortages.

Response to Healthcare Issue/Stressor in the Work Setting and Changes Implemented

The prison’s answer to reducing health disparities and improving working conditions primary focus is on recruiting and retaining qualified healthcare workers. APRNs are a part of this innovation. Nurse Practitioners play an integral role in providing healthcare in prisons and primary care settings. Besides, there is an increase in APRNs graduating rates compared with physicians, which creates a change in the workforce without compromising patient care quality or a rise in healthcare cost (Auerbach et al., 2018). The Department of Justice offers retention, recruitment, and relocation pay incentives and student loan repayment to nurses and other healthcare professionals (U.S. Department of Justice, 2016). Likewise, at my correctional institution, there is an exercise center and other wellness programs such as health fairs. With all of these initiatives in place, the correctional facility is becoming more competitive, and hiring increases. Staff morale is improving, which decreases burnout and enhances healthcare quality, reducing disparities NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

Conclusion

Health disparities are a significant problem in the private sector and institutionalized places, but with the effect of the Triple/Quadruple Aim and APRNs, the inequalities can decline.

References

Auerbach, D. I., Staiger, D. O., & Buerhaus, P. I. (2018). Growing ranks of advanced practice clinicians-Implications for the physician workforce. New England Journal of Medicine, 378(25), 2358–2360. https://doi.org/10.1056/NEJMp1801869

Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

Nowotny, K. M., Rogers, R. G., & Boardman, J. D. (2017). Racial disparities in health conditions among prisoners compared with the general population. ScienceDirect, 3, 487–496. https://doi.org/10.1016/j.ssmph.2017.05.011

U.S. Department of Justice. (2016). Federal Bureau of Prisons: Program Statement. Retrieved November 30, 2020, from https://www.bop.gov/policy/progstat/3530.02.pdf

Module 1: Healthcare Environment (Weeks 1-2)

Learning Objectives

Learning Resources 

Required Readings

Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.

• Chapter 2, “Transformational Leadership: Complexity, Change, and Strategic Planning” (pp. 34–62)
• Chapter 3, “Current Challenges in Complex Health Care Organizations and the Quadruple Aim” (pp. 66–97)

Read any TWO of the following (plus TWO additional readings on your selected issue):

Pittman, P., & Scully-Russ, E. (2016). Workforce planning and development in times of delivery system transformation. Human Resources for Health, 14(56), 1–15. doi:10.1186/s12960-016-0154-3. Retrieved from

https://human-resources-health.biomedcentral.com/track/pdf/10.1186/s12960-016-0154-3

Required Media

Laureate Education (Producer). (2015). Leading in Healthcare Organizations of the Future [Video file]. Baltimore, MD: AuthorNURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

Discussion: Review of Current Healthcare Issues

By Day 3 of Week 1

By Day 6 of Week 1

 

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 1

To participate in this Discussion:

Week 1 Discussion

Assignment: Analysis of a Pertinent Healthcare Issue

By Day 7 of Week 2

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment Draft for Authenticity:

Submit your Week 2  Assignment draft and review the originality report

Submit Your Assignment by Day 7 of Week 2

To participate in this Assignment:

Week 2 Assignment

Next Module

To go to the next module:

Module 2

Module 1 Week 1 Main Discussion Post

One health care issue that has been in the news nationally all this year, besides Covid19 that is, is the rising issue of people having to ration their insulin related to increased cost and/or lack of insurance coverage to pay for insulin.  As we all already know, diabetes is one of the predominate health issues facing our society today and the problem is compounded when people cannot afford the increase cost of the life saving insulin or their insurance will not pay these increased costs.  I have firsthand experience with this, as my own father had stop taking his Victoza (not exactly insulin, but still related to diabetes) in October of this year because his insurance coverage would not pay out on it anymore this year.  He was not able buy it on his own because it is insultingly expensive, and instead will have to use less effective oral medications to control his blood sugars for the rest of this year.

There is significant scholarly evidence that this really is a national problem and is effecting patient outcomes negatively.  Fralick discusses why this may be happening, postulating that there are no laws in the United States prohibiting pharmaceutical companies from over pricing and raising the price of their drugs in combination with a lack of competition in the market as most insulin in the US is made by 3 companies (2019).  Fralick also points out the irony of the fact that a drug discovered in the 1920s and universally identified as the ONLY way—at the time—to treat the nearly 100% fatal disease is now today being exploited by pharmaceutical companies for profit (2019) NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

How bad is the problem?  Hart identifies in her research that the cost of insulins has tripled from 2002 to 2013 and then doubled again from that already inflated cost from 2012 to 2016 (2020).  This drastically outpaces any positive change in income most people might experience and can be compounded by a lack of insurance coverage or coverage (such as in my father case) that will not pay for all of the needed and life saving medications.  Pharmaceutical companies are being allowed to place their profit over the lives of the patients their medications are intended to help save.  Heng Nhoung sites that the problem is additionally compounded in cases in which food insecurity, which is defined as lack of consistent access to necessary nutrients, causes the diabetic to engage in the dangerous practice of rationing insulins while also contending with not having enough money for food (2020).  As you can imagine, that is a recipe for disaster.

At my workplace, patients are committed and cannot leave of their own accord.  This means that compared to other patients, or even their own situations when not in the facility, are actually better off.  The State of Minnesota purchases the necessary insulins for our patients regardless of cost.  However, that does not mean adjustments have not been made.  We have now switched to Semglee instead of Lantus.  Semglee is chemical similar to Lantus and nearly identical in function, but significantly less expensive.  My parents have been told by their Medicare Part-D provider that regular insulins will changed with respect to their Medicare coverage and they will no longer have to pay as much for the insulins they need.  However, this change in coverage does not apply to my father’s Victoza.  It is unclear if this change in coverage is limited to just the Part-D supplemental coverage or if Medicare as a whole will have better coverage on insulin.  Somehow, I fear this is NOT the case and probably means that low income diabetic patients who cannot afford Part-D supplemental coverage will continue to be in life threatening trouble NURS 6053/NURS 6053N/NRSE 6053C/NURS 6053C/NURS 6053A/NRSE 6053A: Interprofessional Organizational and Systems Leadership.

References

Fralick, M., & Kesselheim, A. S. (2019). The U.S. Insulin Crisis – Rationing a Lifesaving Medication Discovered in the 1920s. The New England Journal of Medicine, 19, 1793.

Hart, L. (2020). Insulin Rationing. The Journal for Nurse Practitioners, 16(3), 213–217. https://doi-org.ezp.waldenulibrary.org/10.1016/j.nurpra.2019.10.023

Heng Ky Nhoung, Goyal, M., Cacciapuoti, M., Day, H., Hashemzadeh, T., Magee, M., & Jarris, Y. S. (2020). Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 21(4), 959–963. https://doi-org.ezp.waldenulibrary.org/10.5811/westjem.2020.4.45918